MEDICARE: JESSICA ANNE KRUSE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6965TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50149380	OTHER	TX	DPS

General Provider Information

NPI Number	:	1497974877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANNE KRUSE O.D.

Provider Business Mailing Address
First Line	:	1546 STACY RD
Second Line	:	SUITE100
City	:	ALLEN
State	:	TX
Zip	:	75002-8726
Country	:	US
Telephone Number	:	214-383-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 STACY RD
Second Line	:	SUITE100
City	:	ALLEN
State	:	TX
Zip	:	75002-8726
Country	:	US
Telephone Number	:	214-383-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/07/2023

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